Abstract: Background  At present，dietary and nutrition interventions and exercise are major treatments for patients with gestational diabetes mellitus（GDM） and hyperlipidemia.Objective  To explore the effects of nutrition support in combination with interventions with dietary fiber and resistance exercise on GDM with hyperlipidemia.Methods  206 women who had GDM and hyperlipemia during the second and third trimesters of pregnancy were recruited from Luohe Central Hospital from December 2014 to December 2016 and were randomized into the control group（n=49），dietary fiber group（n=51），resistance exercise group（n=52），and combination group（n=54），receiving basic nutrition support，basic nutrition support and intervention with dietary fiber，basic nutrition support and resistance exercise，basic nutrition support with interventions with dietary fiber and resistance exercise，respectively.The intervention for all cases lasted for 12 weeks.Glycemic and lipid outcomes were evaluated by fasting blood glucose（FPG），2-hour postprandial blood glucose（2 hPG），glycosylated hemoglobin（HbA1c），triglyceride（TG），and total cholesterol（TC） at the end of the 4th and 12th weeks of intervention.Quality of life outcome was evaluated by the Adjusted Diabetes-specific Quality of Life（A-DQOL） at the end of the 4th and 12th weeks of intervention.And pregnancy outcome was assessed at the end of intervention.Results  FPG，2 hPG，HbA1c，TG and TC of the four groups at the end of the 4th and 12th weeks of intervention were significantly different（P<0.05）．To be specific，at the end of the 4th week of intervention，combination group showed significantly decreased FPG，2 hPG，HbA1c，TG and TC levels than the control group，and significantly decreased 2 hPG than dietary fiber group，and resistance exercise group（P<0.05）．When the intervention ended，combination group demonstrated significantly decreased FPG，2 hPG，HbA1c，TG and TC levels than the control group，too（P<0.05）．Moreover，in comparison with dietary fiber group and resistance exercise group，combination group demonstrated significantly decreased 2 hPG and HbA1c（P<0.05）．The rates of adverse pregnancy outcomes，such as preeclampsia，polyhydramnios，preterm labor，cesarean section and macrosomia differed significantly in the groups（P<0.05）．In particular，they were significant lower in the combination group than those of other groups（P<0.008 3）．At the end of 4th and 12th weeks of intervention，the mean A-DQOL score varied significantly in all the groups（P<0.05），and it was much lower in the combination group than that of other groups（P<0.05）．Conclusion  Basic nutrition support with interventions with dietary fiber and resistance exercise，helps to achieve effective glycemic and blood lipid control，improve the pregnancy outcome and quality of life in GDM patients with hyperlipidemia.

Key words: Dietary fiber；Resistance exercise；Diabetes, gestational；Hyperlipidemias；Quality of life

摘要： 背景  目前膳食营养干预和运动是妊娠糖尿病（GDM）合并脂代谢障碍患者主要的基础治疗手段。目的  探讨在膳食营养支持治疗的基础上给予膳食纤维联合抗阻运动对妊娠糖尿病（GDM）合并高脂血症的干预效果。方法  选取2014年12月—2016年12月漯河市中心医院收治的孕中晚期糖尿病合并高脂血症患者206例为研究对象。随机分成4组：对照组（n=49）、膳食纤维组（n=51）、抗阻运动组（n=52）、联合组（n=54）。对照组仅给予基础膳食营养支持治疗，膳食纤维组患者在对照组的基础上添加膳食纤维方案，抗阻运动组在对照组的基础上添加运动干预方案，联合组在对照组的基础上同时添加膳食纤维方案和运动干预方案。干预周期为3个月，分别于干预前、干预第4周时、第12周时检测4组患者空腹血糖（FPG）和餐后2 h血糖（2 hPG）、糖化血红蛋白（HbA1c）、三酰甘油（TG）、总胆固醇（TC）水平，同时采用糖尿病特异性生活质量测定量表（A-DQOL）进行跟踪评测，至干预12周后记录患者妊娠结局。结果  4组患者在干预第4周和第12周时FPG、2 hPG、HbA1c、TG、TC比较，差异有统计学意义（P<0.05）。联合组在干预第4周和第12周时FPG、2 hPG、HbA1c、TG、TC明显低于对照组（P<0.05）；联合组在干预第4周和第12周时2 hPG明显低于膳食纤维组、抗阻运动组，干预第12周时HbA1c明显低于膳食纤维组、抗阻运动组（P<0.05）。4组患者子痫前期、羊水过多、早产、剖宫产、巨大儿的发生率比较，差异有统计学意义（P<0.05）。联合组子痫前期、羊水过多、早产、剖宫产、巨大儿的发生率明显低于对照组（P<0.008 3）。4组随访第4周和第12周时A-DQOL评分比较，差异有统计学意义（P<0.05）。膳食纤维组、抗阻运动组、联合组随访第4周和第12周时A-DQOL评分低于对照组，联合组随访第4周和第12周时A-DQOL评分低于膳食纤维组、抗阻运动组（P<0.05）。结论  膳食纤维联合抗阻运动能有效控制GDM患者的血糖、血脂水平，改善妊娠结局，且能明显提高患者的生活质量。

关键词: 膳食纤维；抗阻运动；糖尿病, 妊娠；高脂血症；生活质量